CBCT provides additional diagnostic information in patients with atypical odontalgia

Methods: Participants were 25 patients (mean age 54±11 years, range 34–72) diagnosed with AO (n=20) or with SAP (control group, n=5) and referred to the Departments of Stomatognathic Physiology or Endodontics, Faculty of Odontology at Malmö University, or recruited from the emergency clinic of the same faculty. Inclusion criteria for AO were: chronic pain (>6 months) located in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiological examinations; and for SAP: recurrent pain from a tooth diagnosed with apical periodontitis in a clinical and radiographic examination. The assessments comprised a clinical examination, a self-report questionnaire and a radiographic examination including panoramic and intraoral radiographs and CBCT. Main outcome measure was periapical bone destruction. Other findings in the pain area were also recorded. Two specialists in oral radiology assessed all radiographs, and observer agreement was calculated using kappa.

Results: In AO group, average pain intensity was 5.6(±1.8) on a numerical rating scale (NRS 0–10) and average pain duration 4.3(±5.2) years. In 5/20 patients, periapical bone destruction not detectable in conventional radiographs was found with CBCT, thus identifying 15/20 patients without any periapical bone destructions in the painful area. Inter-and intra-observer agreement ranged from poor to good (0.19–0.65).

Conclusion: CBCT can improve the possibilities to identify patients without periapical bone destruction, which may facilitate differentiation between AO and SAP. The Faculty of Odontology at Malmö University supported this study.